Comparison of Quadratus Lumborum Block and Epidural Analgesia Following Kidney Transplant Surgery

Indonesia University50 enrolled

Overview

Quadratus lumborum block as an alternative for postoperative analgesia compared with epidural block

Epidural analgesia is the main choice of analgesia following kidney transplant surgery. However, continuous epidural technique had some concerning side effects such as hemodynamic instabilities, urine retention, motor/sensory disturbances/weakness, and mobilisation comfort, it could also cause hypotension which could affect graft success. Quadratus lumborum (QL) block had lesser side effects thus could be an option for postoperative analgesia, however there are no study showing the safety and success rate of QL block techniques for patients who underwent kidney transplant surgery.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

Conditions

Postoperative Pain

Interventions

Continuous Epidural analgesiaPROCEDURE

Continuous Epidural catheter is inserted at the Thoracic 11-T12 level, using Ropivacaine 0.375% 3 mL bolus followed by Ropivacaine 0.2% with rate 6 mL/hour for 24 hours after laparoscopic nephrectomy

Bilateral Quadratus Lumborum blockPROCEDURE

Bilateral anterior Quadratus Lumborum block using Ropivacaine 0.375% 20 mL each injection as postoperative analgesia treatment for 24 hours

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Patients undergoing elective kidney transplant laparotomy surgery * Agrees to participate in research * BMI \< 30 kg/m2 Exclusion Criteria: * Declines to participate in research * Contraindications to intervention procedures (epidural or quadratus lumborum block) * History of local anaesthetic allergy * Systemic allergic reactions, anaphylactic reaction, cardiac arrest * Failure of intervention procedures (epidural or quadratus lumborum block) * Intraoperative complications (massive bleeding, hypotension)

Locations (1)

Rumah Sakit Cipto Mangunkusumo

Jakarta Pusat, DKI Jakarta, Indonesia

Outcomes

Primary Outcomes

Morphine consumption

Additional analgesia required at 2, 6, 12, and 24 hours after surgery

Time frame: 24 hours

Secondary Outcomes

Pain Intensity

Pain intensity measured using the Visual Analogue Scale (VAS) at 2, 6, 12, and 24 hours after surgery. VAS assessed with horizontal line 0-100 mm for no pain to the worst pain, with range 0-30 mm for none to mild pain, 31-70 mm for moderate pain, 71-100 mm for severe pain.

Time frame: 24 hours

First time morphine required

Total time gap from postoperative analgesia procedure administration to first morphine requirement

Time frame: 24 hours

Total minimum and maximum dose of vasoactive agents

Minimum and maximum dose of norepinephrine and dobutamine as vasoactive agents within 24 hours after surgery

Time frame: 24 hours

Urine output

Urine output (mL/kgBW/hour) after surgery

Time frame: 24 hours

Bromage score

Bromage score at 2, 6, 12, and 24 hours after surgery to assess lower limb motoric block. Score for Bromage: 1. free movement 2. partial block 3. almost complete 4. complete block

Time frame: 24 hours

Ramsay score

Ramsay score at 2, 6, 12, and 24 hours after surgery to assess patient sedation level.

Time frame: 24 hours

Dermatomal coverage of analgesia procedure

Data from ClinicalTrials.gov

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